Radiology Digest – October 31, 2023

October 27, 2023

Radiology Digest: News from the week of October 31, 2023.

The Physician Shortage is Here: AMA Implores Congress to Address ‘Urgent Crisis’

By Marty Stempniak | October 25, 2023 | Included in Radiology Digest – October 31, 2023

In a national address Wednesday, the president of the American Medical Association implored Congress to address the growing shortage of radiologists and other physicians that is crippling the U.S. healthcare system.

Anesthesiologist Jesse M. Ehrenfeld, MD, MPH, delivered his remarks at the National Press Club in Washington, highlighting the growing list of challenges physicians are facing in 2023. These include “enormous” administrative burdens, burnout, attacks on science, consolidation and a “broken” Medicare payment system.

Ehrenfeld—who took over the AMA leadership role in June—implored lawmakers to address these issues before they worsen.

“Physicians everywhere—across every state and specialty—continue to carry tremendous burdens that have us frustrated, burned out, abandoning hope … and in increasingly worrying numbers, turning our backs on the profession we’ve dedicated our lives to,” Ehrenfeld said Wednesday.

He offered up five potential solutions to address the crisis and boost the physician workforce:Pass meaningful Medicare payment reform.Reduce administrative burdens such as the “overused, inefficient” prior authorization process.Pass bipartisan legislation to expand residency training options, provide greater student loan support and create smoother pathways for foreign-trained physicians.

End the “criminalization of healthcare,” a reference to the overturning of Roe v. Wade and efforts to curtail the delivery of healthcare services to trans patients. Fourteen states have banned abortion, Ehrenfeld noted, while 22 have enacted laws restricting or banning gender-affirming care.

Ensure physicians are not punished for taking care of their mental health needs—1 in 10 physicians did not seek mental health treatment because they feared their medical board or employer might find out, according to a recent Medscape survey.

To read more, go to Radiology Business.


Patient Access, Registration Errors Lead to Most Claim Denials

By Jacqueline LaPointe | October 25, 2023 | Included in Radiology Digest – October 31, 2023

Hospitals and health systems are facing more claim denials as front-end revenue cycle processes lead to errors.

A recent survey conducted by the Healthcare Financial Management Association’s Pulse Survey program for AKASA polled more than 350 CFOs and revenue cycle leaders at hospitals and health systems. Nearly half of the financial leaders (47 percent) said claim denial rates increased compared to last year, with 37 percent reporting an increase of at least 5 percent.

While most hospitals and health systems saw a significant increase in claim denial rates, only 2 percent of respondents said their claim denial rates decreased by 5 percent or more. Meanwhile, 27 percent said there was no change in claim denial rates versus last year and 24 percent reported a decrease under 5 percent.

As claim denial rates ticked up, healthcare CFOs and revenue cycle leaders agreed that errors on the front end of the revenue cycle caused the most claim denials.

When asked to rank the most common reasons for initial claim denials, the top reason was errors in patient access and registration. This means eligibility errors and missing prior authorizations were the most common reasons for hospital claim denials this year.

Healthcare CFOs and revenue cycle leaders also ranked a lack of documentation to support medical necessity and missing or incorrect patient information as the most common reasons for initial claim denials behind errors in patient access and registration.

Other reasons for initial claim denials included physician documentation issues, utilization management, coding errors, duplicate claims, and untimely filing.

Claim denials are an expensive problem for healthcare providers. Another recent survey conducted by Plutus Health found that claim denials are the greatest revenue cycle management challenge for healthcare organizations as the process faces regular backlogs. More than one in five respondents (22 percent) said organizations — which generate annual revenues between $25 million and $5 billion — lose over half a million dollars in annual revenue each year because of denied claims.

Healthcare organizations are making claims denial management a top priority as they cannot afford to lose more money. Trends in initial claim denials indicate a need to improve front-end revenue cycle processes to prevent denials from happening in the first place.

“This new data confirms what we all know: Issues at the front end trickle down into the entire reimbursement process. When your patient access operations run smoothly, you’re setting your downstream workflows and teams up for success,” Amy Raymond, SVP of revenue cycle operations and deployments at AKASA, said in the survey.

To read more, go to Revcycle Intelligence.


Congress Must Protect Physicians from Medicare Cuts: MGMA

By Richard Payerchin | October 24, 2023 | Included in Radiology Digest – October 31, 2023

Medicare cuts are coming and that’s bad news for physicians, but there is still time for federal lawmakers to act.

The Medical Group Management Association (MGMA) submitted its policy analysis on Medicare in comments for the House Committee on Energy & Commerce. The committee’s Subcommittee on Health has been meeting this month to discuss pending legislationpressing issues in health care, and how federal regulations are affecting physicians, patients, and the health care sector.

Debate and testimony started in the hearing “What’s the Prognosis? Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.” MGMA Senior Vice President-Government Affairs Anders Gilberg submitted written comments for that hearing.

“While MGMA is supportive of a fiscally responsible Medicare system that puts patients first, we remain concerned that current policies place unnecessary administrative burdens on medical groups, thus impacting access to care,” said the letter from Gilberg to subcommittee Chair Rep. Brett Guthrie (R-Kentucky) and Ranking Member Rep. Anna Eshoo (D-California).

Next year could bring a 3.36% cut in the conversion factor, as proposed by the U.S. Centers for Medicare & Medicaid Services. Congress needs to work stop that, Gilberg said. From 2001 to this year, Medicare physician payment has effectively decreased by 26% when adjusted for inflation, he said.

An alternative is in the bill known as the “Strengthening Medicare for Patients and Providers Act.” It would create a yearly Medicare physician payment update tied to inflation, based on the Medicare Economic Index, Gilberg said.

“Addressing the proposed conversion factor cut and providing sustainable reimbursement will allow medical groups to thrive and focus on providing high-quality care,” he said in the letter.

You can take action on H.R. 2472 – Strengthening Medicare for Patients and Providers Act here.

To read more, go to Medical Economics.


8 Providers Being Acquired by Payers

By Rylee Wilson | October 23, 2023 | Included in Radiology Digest – October 31, 2023

Here are eight providers that payers have acquired or announced plans to acquire in 2023: 

1. BCBS North Carolina plans to purchase all 55 North Carolina locations of FastMed, a national chain of urgent care clinics.

2. Humana‘s CenterWell Primary Care will purchase the bulk of Cano Health’s centers in Texas and Nevada for $66.7 million.

3. UnitedHealth Group’s Optum plans to merge with home health and hospice provider Amedisys. The $3.3 billion deal was green-lighted by shareholders but faces scrutiny from the Justice Department.

4. CareSource plans to acquire a new affiliate, Radiant Alliance, a nonprofit organization composed of Metta Healthcare, the parent company of Ohio’s Hospice and Pure Healthcare, and United Church Homes, pending regulatory approval. Metta Healthcare employs more than 1,400 people in 59 countries throughout Ohio and provides long term care for those with chronic illness or in need of end-of-life care.

5. CVS Health completed its $10.6 billion acquisition of primary care company Oak Street Health.

6. UnitedHealth Group’s recently acquired LHC Group plans to buy Delaware-based home health company Summit Home Care.

7. Optum purchased Middletown, N.Y.-based Crystal Run Healthcare, a multispecialty physician group with over 400 providers across more than 30 locations.

8. UnitedHealth Group closed on its $5.4 billion acquisition of home health firm LHC Group in February. Lafayette, La.-based LHC employs about 30,000 people, including front-line care providers and administrative and support personnel. Many of LHC’s home-health and hospice operations are owned in partnership with hospital systems across 37 states and more than 960 locations. 

To read more, go to Becker’s Payer Issues.


Reducing Barriers to MIPS, Advanced APMs Could Promote Participation

By Victoria Bailey | October 23, 2023 | Included in Radiology Digest – October 31, 2023

Reducing barriers to Advanced Alternative Payment Model (APM) participation for physicians in rural areas could help promote value-based care and control rising Medicare spending, according to research from the US Government Accountability Office (GAO).

Both Medicare enrollment and spending are expected to increase in the coming years, highlighting the urgency to control expenditures within the program. Medicare payments to physicians account for around 18 percent of spending. In 2021, Medicare payments to 1.3 million physicians and other providers totaled $93 billion.

Incentivizing high-quality, efficient care not only improves patient experiences but can also help reduce Medicare spending.

GAO conducted reports in October 2021, November 2021, and February 2022 on the Merit-based Incentive Payment System (MIPS), Advanced APMs, and geographic adjustments to physician payments.

Under the Quality Payment Program, most Medicare physicians must participate in either MIPS or an Advanced APM. In MIPS, providers receive a positive, neutral, or negative payment adjustment depending on their performance score.

The October 2021 report found that at least 93 percent of providers in MIPS qualified for a positive payment adjustment, while less than 5 percent qualified for a negative payment adjustment between 2017 and 2019. Positive payment adjustments ranged up to 1.88 percent.

Provider groups reported that the performance category exemption and the low-volume threshold exemption reduced participation burden. Meanwhile, poor performance feedback, questionable impacts of some reporting measures, and a low return on investment created challenges for providers.

Under the Advanced APM track, providers are encouraged to share in the financial rewards and the risk of caring for Medicare beneficiaries. Participating providers who achieve a certain payment or patient count threshold receive an incentive payment.

The November 2021 report found that fewer providers in rural or health professional shortage areas participated in Advanced APMs in 2019. Specifically, the report found that 12 percent of eligible providers in rural or shortage areas participated in an Advanced APM, compared to 15 percent of eligible providers in other areas.

To read more, go to Revcycle Intelligence.


Prior Authorization for Imaging Causing Anxiety, Administrative Burden for Cancer Patients

By Marty Stempniak | October 20, 2023 | Included in Radiology Digest – October 31, 2023

Prior authorization for imaging and other services is increasing anxiety and administrative burdens for cancer care patients, according to new survey data published in JAMA Network Open [1].

Memorial Sloan Kettering recently conducted the single-center anonymous survey, aiming to gauge how these health insurer-imposed impediments may impact the patient experience. Investigators utilized social media and email lists from cancer advocacy organizations, reaching a total of 178 individuals over a three-month period last year.

Of those, 69% (123) reported a prior authorization-related delay in care, with 73% of that sample (90) experiencing setbacks lasting two weeks or longer. Prior authorization was most frequently required for imaging (71% or 126 patients), followed by IV chemotherapy (49%/87), surgery (47%/84) and radiotherapy (34%/60). Alarmingly, about 22% of patients did not receive the care recommended by their treatment team because of prior authorization, researchers reported.

“Focusing on patient experiences with PA highlights a missing perspective in policy discussions and suggests another potential factor associated with eroding trust in the healthcare system,” Fumiko Chino, MD, with the Department of Radiation Oncology at New York-based MSK, and colleagues concluded. “Streamlining the PA process is key to optimizing the quality of care delivered and improving patients’ experience with cancer care.

Policy interventions will be necessary to reform the PA process, as will advocacy efforts at the patient, clinician, and hospital level.”

The findings highlight the heavy volume of red tape already-stressed cancer patients must navigate in this process. About 67% of individuals said they had to become personally involved in the PA process, and 20% spent 11 or more hours with such tasks. Asked to rate their experience with prior authorization, 40% labeled it as “bad” and 32% “horrible.” Ratings appeared to correlate with the length of the care delay and time spent on PA. Self-reported PA-related anxiety was higher than typical scores, the authors noted, and also correlated with delay length, time spent on PA and overall experience.

After navigating this issue, 89% of patients said they trusted their insurance company less and 83% felt the same about the healthcare system.

“To our knowledge, this study is the first to ask oncology patients about their experience with PA,” the authors wrote. “Understanding the patient perspective is a vital component of efforts to refine the PA process, given that patients (and their families) are ultimately financially responsible for resultant medical bills and often must take on the administrative burdens of PA while simultaneously managing the physical and psychosocial effects of their disease and treatment.”

To read more, go to Radiology Business.


American College of Radiology Expects Volume of ‘Dangerous’ Scope-expansion Bills to Grow in 2024

By Marty Stempniak | October 20, 2023 | Included in Radiology Digest – October 31, 2023

The American College of Radiology said Thursday that it expects the volume of “dangerous” bills, aimed at broadening nonphysicians’ authority, to grow in 2024.

This year alone, ACR has tracked more than 100 proposed policies relating to radiologic scope-of-practice expansion, spanning 30 states. In one example, ACR and the South Dakota Radiological Society helped quash a measure that would have allowed experienced physician assistants to take X-rays and perform radiologic procedures autonomously.

Amid a strained hiring environment and rising imaging volumes, advocates anticipate that state legislatures will propose more such policies in the coming months.

“The American College of Radiology government relations staff is developing strategies to help state radiological societies fight dangerous nonphysician providers’ scope-of-practice expansion legislation,” the trade group said in an Oct. 19 news update. “ACR and the state societies believe as the provision of healthcare throughout the country becomes more complex, a fully coordinated, quality-focused and patient-centered healthcare team is the optimal means by which patients will receive their healthcare.”

ACR urged members of the specialty to view its policy map related to this topic, along with other resources.
Earlier this month, the college also alerted the Veterans Administration about the potential danger of expanding nonphysicians’ practice authority. The warning came as the VA recently held listening sessions exploring whether to modify its National Standards of Practice.

To read more, go to Radiology Business.

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